Striatal grey matter increase in patients suffering from fibromyalgia – A voxel-based morphometry study

Abstract Fibromyalgia (FM), among other chronic pain syndromes, such as chronic tension type headache and atypical face pain, is classified as a so‐called dysfunctional pain syndrome. Patients with fibromyalgia suffer from widespread, “deep” muscle pain and often report concomitant depressive episodes, fatigue and cognitive deficits. Clear evidence for structural abnormalities within the muscles or soft tissue of fibromyalgia patients is lacking. There is growing evidence that clinical pain in fibromyalgia has to be understood in terms of pathological activity of central structures involved in nociception. We applied MR‐imaging and voxel‐based morphometry, to determine whether fibromyalgia is associated with altered local brain morphology. We investigated 20 patients with the diagnosis of primary fibromyalgia and 22 healthy controls. VBM revealed a conspicuous pattern of altered brain morphology in the right superior temporal gyrus (decrease in grey matter), the left posterior thalamus (decrease in grey matter), in the left orbitofrontal cortex (increase in grey matter), left cerebellum (increase in grey matter) and in the striatum bilaterally (increase in grey matter). Our data suggest that fibromyalgia is associated with structural changes in the CNS of patients suffering from this chronic pain disorder. They might reflect either a consequence of chronic nociceptive input or they might be causative to the pathogenesis of fibromyalgia. The affected areas are known to be both, part of the somatosensory system and part of the motor system.

[1]  Leslie J Crofford,et al.  Perception of noxious and innocuous heat stimulation among healthy women and women with fibromyalgia: association with mood, somatic focus, and catastrophizing , 2003, Pain.

[2]  M. Pierrynowski,et al.  Women with fibromyalgia walk with an altered muscle synergy. , 2005, Gait & posture.

[3]  R. Peyron,et al.  Functional imaging of brain responses to pain. A review and meta-analysis (2000) , 2000, Neurophysiologie Clinique/Clinical Neurophysiology.

[4]  D. Clauw,et al.  Pain catastrophizing and neural responses to pain among persons with fibromyalgia. , 2004, Brain : a journal of neurology.

[5]  U. Egle,et al.  [Diagnostic subgroups and psychosocial characteristics in chronic non-malignant pain patients referred to an out-patient pain center]. , 2002, PPmP. Psychotherapie, Psychosomatik, medizinische Psychologie.

[6]  C. Vierck,et al.  Abnormal sensitization and temporal summation of second pain (wind-up) in patients with fibromyalgia syndrome , 2001, Pain.

[7]  K. Pile,et al.  Regional cerebral blood flow in fibromyalgia: single-photon-emission computed tomography evidence of reduction in the pontine tegmentum and thalami. , 2000, Arthritis and rheumatism.

[8]  M. W. Stenekes,et al.  Cerebral reorganisation of human hand movement following dynamic immobilisation , 2003, Neuroreport.

[9]  P. Salmon,et al.  Biological and psychological factors associated with memory function in fibromyalgia syndrome. , 2003, Health psychology : official journal of the Division of Health Psychology, American Psychological Association.

[10]  Karl J. Friston,et al.  A Voxel-Based Morphometric Study of Ageing in 465 Normal Adult Human Brains , 2001, NeuroImage.

[11]  R. Melzack.  The McGill Pain Questionnaire: Major properties and scoring methods , 1975, PAIN.

[12]  A. Holman,et al.  A randomized, double-blind, placebo-controlled trial of pramipexole, a dopamine agonist, in patients with fibromyalgia receiving concomitant medications. , 2005, Arthritis and rheumatism.

[13]  A Straube,et al.  Gray matter decrease in patients with chronic tension type headache , 2005, Neurology.

[14]  J. Suhr.  Neuropsychological impairment in fibromyalgia: relation to depression, fatigue, and pain. , 2003, Journal of psychosomatic research.

[15]  M. D. Egger,et al.  Formation of New Connexions in Adult Rat Brains after Partial Deafferentation , 1971, Nature.

[16]  Jason Steffener,et al.  Functional imaging of pain in patients with primary fibromyalgia. , 2004, The Journal of rheumatology.

[17]  Rolf-Detlef Treede,et al.  Spatial resolution of fMRI in the human parasylvian cortex: Comparison of somatosensory and auditory activation , 2005, NeuroImage.

[18]  Daniel J Clauw,et al.  Functional magnetic resonance imaging evidence of augmented pain processing in fibromyalgia. , 2002, Arthritis and rheumatism.

[19]  Martin Ingvar,et al.  Imaging cognitive modulation of pain processing , 2002, Pain.

[20]  Karl J. Friston,et al.  Voxel-Based Morphometry—The Methods , 2000, NeuroImage.

[21]  A. Beck,et al.  Internal consistencies of the original and revised Beck Depression Inventory. , 1984, Journal of clinical psychology.

[22]  P. Wood.  Stress and dopamine: implications for the pathophysiology of chronic widespread pain. , 2004, Medical hypotheses.

[23]  Karl J. Friston,et al.  Correlation between structural and functional changes in brain in an idiopathic headache syndrome , 1999, Nature Medicine.

[24]  A. Bengtsson,et al.  Living with Fibromyalgia: Consequences for Everyday Life , 1992, The Clinical journal of pain.

[25]  John McBeth,et al.  Hypothalamic-pituitary-adrenal stress axis function and the relationship with chronic widespread pain and its antecedents , 2005, Arthritis research & therapy.

[26]  A. Apkarian,et al.  Chronic Back Pain Is Associated with Decreased Prefrontal and Thalamic Gray Matter Density , 2004, The Journal of Neuroscience.

[27]  Bryan Kolb,et al.  Structural plasticity associated with exposure to drugs of abuse , 2004, Neuropharmacology.

[28]  G. Sella,et al.  Diffuse muscular coactivation (DMC) as a potential source of pain in fibromyalgia -- part 1. , 2002, NeuroRehabilitation.

[29]  E G Jones,et al.  Thalamic and brainstem contributions to large-scale plasticity of primate somatosensory cortex. , 1998, Science.

[30]  K. Lieb,et al.  Substance P and Substance P Receptor Antagonists in the Pathogenesis and Treatment of Affective Disorders , 2003, The world journal of biological psychiatry : the official journal of the World Federation of Societies of Biological Psychiatry.

[31]  J. Türp,et al.  [Functional somatic pain syndromes-nomenclature]. , 2004, Schmerz.

[32]  Karl J. Friston,et al.  Voxel-Based Morphometry of Herpes Simplex Encephalitis , 2001, NeuroImage.

[33]  Bogdan Draganski,et al.  Affective components and intensity of pain correlate with structural differences in gray matter in chronic back pain patients , 2006, Pain.

[34]  D. Price,et al.  Neurobiology of fibromyalgia syndrome. , 2005, The Journal of rheumatology. Supplement.

[35]  P. Tugwell,et al.  The American College of Rheumatology 1990 Criteria for the Classification of Fibromyalgia. Report of the Multicenter Criteria Committee. , 1990, Arthritis and rheumatism.

[36]  J. Bremner,et al.  Neuroanatomical Changes Associated with Pharmacotherapy in Posttraumatic Stress Disorder , 2004, Annals of the New York Academy of Sciences.

[37]  J. Mountz,et al.  Fibromyalgia in women. Abnormalities of regional cerebral blood flow in the thalamus and the caudate nucleus are associated with low pain threshold levels. , 1995, Arthritis and rheumatism.

[38]  Roland Staud,et al.  Isometric exercise has opposite effects on central pain mechanisms in fibromyalgia patients compared to normal controls , 2005, Pain.

[39]  C Büchel,et al.  Somatotopic representation of nociceptive information in the putamen: an event-related fMRI study. , 2004, Cerebral cortex.